Personal view: a day in the life of an emergency physician at war; the reality of emergency medicine in the war arena.(War)

I would not regard myself as superstitious, but 13 April 2003 was not what I would call a lucky day. It was the 22nd day of the ground war in Iraq and I was the officer in command of the emergency department of 34 Field Hospital. Seventeen days previously this had moved into Iraq in support of the 1st (UK) Armoured Division and had begun treating battle casualties on 27 March. Unusually the hospital was colocated far forward with the infantry and armour units on a disused military airfield close to the city of Al Basrah. By this time in the war the explosions around the perimeter had become less frequent, and the hostile incoming mortar and artillery fire had stopped. Challenger II tanks of the Scots Dragoon Guards and 2 Royal Tank Regiment could no longer be seen racing across the desert and engaging targets; and the nightly firework display of tracer from heavy artillery lobbing rounds across our accommodation tents had also ceased (an event that would wake even the heaviest sleeper, and cover the tent in gunpowder).

The day had started inspiringly at 0700 hours with a medley of marching music from the attached military band practising outside A&E, poignantly interspersed with the Last Post from a cornet player raised on a flat bed truck against a sky darkened by oil pit fires. An hour later the first routine of the day was the heads of department attending the Commanding Officer's briefing ("Orders Group"). Serious business in hand, the Regimental Sergeant Major had stated that the …